Prevalence and associated factors of liver fibrosis and steatosis in Gansu, China: a community-based cross-sectional study

BACKGROUND: The epidemiology of chronic liver disease in China is undergoing a major transition, shifting from a predominance of viral hepatitis to metabolic-associated liver disease. However, population-based data from Northwest China remain limited. This study aimed to assess the prevalence and independent associated factors of liver fibrosis and steatosis in the general population of Gansu Province, China. METHODS: We conducted a community-based cross-sectional study across three regions in Gansu Province (Huining, Jingtai, and Jingyuan), enrolling 5,043 eligible participants between January and December 2025. All participants underwent anthropometric measurements, laboratory testing, and transient elastography (TE), and completed a structured questionnaire. Liver fibrosis and steatosis were assessed using the liver stiffness measurement (LSM) and ultrasound attenuation parameter (UAP), respectively. Fibrosis was staged as F0 (LSM < 7.3 kPa), F1 (7.3 ≤ LSM < 7.85), F2 (7.85 ≤ LSM < 10.0 kPa), and F3-4 (LSM ≥ 10.0 kPa). Steatosis grades S1 (mild), S2 (moderate), and S3 (severe) were defined using UAP cutoff values of 244, 269, and 296 dB/m, respectively. Independent associated factors were identified using multivariate logistic regression analysis. RESULTS: Among 5,043 participants (median age 46 years; 59.8% female), significant fibrosis (≥ F2) was observed in 5.18% (95% CI: 4.56-5.79), and advanced fibrosis or cirrhosis (F3-4) in 1.67% (95% CI: 1.31-2.02). The prevalence of liver steatosis (≥ S1) was 50.45% (95% CI: 49.07-51.85), including 26.87% with moderate-to-severe steatosis (≥ S2) and 7.16% with severe steatosis (S3). Multivariate analysis identified HBV infection (OR 3.19, 95% CI: 1.72-5.92), obesity (OR 5.14, 95% CI: 4.14-8.42), diabetes (OR 3.55, 95% CI: 2.02-6.25), elevated ALT (OR 3.86, 95% CI: 2.96-7.60), and decreased PLT (OR 6.45, 95% CI: 2.03-20.52) as independent factors cross-sectionally associated with advanced fibrosis. Severe steatosis was independently associated with obesity (OR 17.62, 95% CI: 13.50-23.01), diabetes (OR 1.73, 95% CI: 1.17-2.55), hypertension (OR 1.50, 95% CI: 1.14-1.96), dyslipidemia (OR 1.36, 95% CI: 1.04-1.78), decreased PLT (OR 4.16, 95% CI: 1.46-11.84), elevated ALT (OR 2.17, 95% CI: 1.46-3.22) and male sex (OR 1.70, 95% CI: 1.18-2.46). CONCLUSIONS: Hepatic steatosis was prevalent in this community population of Gansu Province, whereas clinically significant or advanced liver fibrosis remained relatively modest and was predominantly concentrated within high-risk metabolic and viral subgroups. These findings highlight the urgent need for integrated metabolic and viral screening strategies to enable early identification and prevention of progression to advanced liver disease in this high-risk population.